Skip to main content

Advertisement

SpringerLink
Log in

Risk of ischemia in glioma surgery: comparison of first and repeat procedures

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

The role of repeat resection in the multimodal treatment of gliomas is unclear. Repeat surgery theoretically carries a higher risk of inducing neurological deficits, which might even out any advantage of cytoreduction. We sought to determine whether the occurrence of perioperative infarction is higher for repeat surgery than for first surgery, and sought to identify factors associated with the occurrence of postoperative infarction. Therefore, we searched our database to identify patients who were operated for primary or recurrent glial tumors between October 2007 and October 2010. We analyzed 177 procedures, of which 130 (73.4%) were first surgeries and 47 (26.5%) were repeat. Initial WHO grades, KPS scores, and age were evenly distributed between the groups. Forty-six (26.0%) patients had new DWI lesions on their postoperative MRI scan. Eighteen (10.2%) patients had new lesions greater than 4 cm3. Among these were 11 (6.2%) patients, for whom the new lesion caused neurologic deficit. There was no difference between first and repeat surgery with regard to the occurrence of new DWI lesions (27.7 vs. 21.3%, P = 0.77) or neurological deficits (10.0 vs. 10.6%, P = 1.0). Tumor location in the insula, operculum, and temporal lobe was found to be significantly associated with the occurrence of new DWI lesions. We conclude that repeat surgery should not be withheld as a treatment option for patients with recurrent gliomas for fear of a higher risk of postoperative infarction or new neurologic deficit than the first surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Schafer N, Tichy J, Thanendrarajan S, Kim Y, Stuplich M, Mack F, Rieger J, Simon M, Scheffler B, Bostrom J, Steinbach JP, Herrlinger U, Glas M (2011) Ifosfamide, carboplatin and etoposide in recurrent malignant glioma. Oncology 80(5–6):330–332

    Article  PubMed  CAS  Google Scholar 

  2. Gilbert MR, Kuhn J, Lamborn KR, Lieberman F, Wen PY, Mehta M, Cloughesy T, Lassman AB, Deangelis LM, Chang S, Prados M (2011) Cilengitide in patients with recurrent glioblastoma: the results of NABTC 03-02, a phase II trial with measures of treatment delivery. J Neurooncol (Epub ahead of print)

  3. Nieder C, Astner ST, Mehta MP, Grosu AL, Molls M (2008) Improvement, clinical course, and quality of life after palliative radiotherapy for recurrent glioblastoma. Am J Clin Oncol 31(3):300–305

    Article  PubMed  Google Scholar 

  4. Mandl ES, Dirven CM, Buis, Postma TJ, Vandertop WP (2008) Repeated surgery for glioblastoma multiforme: only in combination with other salvage therapy. Surg Neurol 69(5):506–509. doi:10.1016/j.surneu.2007.03.043 discussion 509

    Article  PubMed  Google Scholar 

  5. Easaw JC, Mason WP, Perry J, Laperriere N, Eisenstat DD, Del Maestro R, Belanger K, Fulton D, Macdonald D (2010) Canadian recommendations for the treatment of recurrent or progressive glioblastoma multiforme. Curr Oncol (Toronto, Ont) 18(3):e126–e136

    Google Scholar 

  6. Barbagallo GM, Jenkinson MD, Brodbelt AR (2008) ‘Recurrent’ glioblastoma multiforme, when should we reoperate? Br J Neurosurg 22(3):452–455. doi:10.1080/02688690802182256

    Article  PubMed  Google Scholar 

  7. Terasaki M, Ogo E, Fukushima S, Sakata K, Miyagi N, Abe T, Shigemori M (2007) Impact of combination therapy with repeat surgery and temozolomide for recurrent or progressive glioblastoma multiforme: a prospective trial. Surg Neurol 68(3):250–254

    Article  PubMed  Google Scholar 

  8. Tofilon PJ, Fike JR (2000) The radioresponse of the central nervous system: a dynamic process. Radiat Res 153(4):357–370

    Article  PubMed  CAS  Google Scholar 

  9. Hwang SY, Jung JS, Kim TH, Lim SJ, Oh ES, Kim JY, Ji KA, Joe EH, Cho KH, Han IO (2006) Ionizing radiation induces astrocyte gliosis through microglia activation. Neurobiol Dis 21(3):457–467

    Article  PubMed  CAS  Google Scholar 

  10. Bernstein M, Gutin PH (1981) Interstitial irradiation of brain tumors: a review. Neurosurgery 9(6):741–750

    Article  PubMed  CAS  Google Scholar 

  11. Quant EC, Drappatz J, Wen PY, Norden AD (2010) Recurrent high-grade glioma. Curr Treat Options Neurol 12(4):321–333

    Article  PubMed  Google Scholar 

  12. Chang SM, Parney IF, McDermott M, Barker FG 2nd, Schmidt MH, Huang W, Laws ER Jr, Lillehei KO, Bernstein M, Brem H, Sloan AE, Berger M (2003) Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 98(6):1175–1181. doi:10.3171/jns.2003.98.6.1175

    Article  PubMed  Google Scholar 

  13. Xu JF, Fang J, Shen Y, Zhang JM, Liu WG, Shen H (2011) Should we reoperate for recurrent high-grade astrocytoma? J Neurooncol 105(2):291–299

    Article  PubMed  Google Scholar 

  14. Combs SE, Thilmann C, Edler L, Debus J, Schulz-Ertner D (2005) Efficacy of fractionated stereotactic reirradiation in recurrent gliomas: long-term results in 172 patients treated in a single institution. J Clin Oncol 23(34):8863–8869

    Article  PubMed  Google Scholar 

  15. Bauman GS, Sneed PK, Wara WM, Stalpers LJ, Chang SM, McDermott MW, Gutin PH, Larson DA (1996) Reirradiation of primary CNS tumors. Int J Radiat Oncol Biol Phys 36(2):433–441

    Article  PubMed  CAS  Google Scholar 

  16. Veninga T, Langendijk HA, Slotman BJ, Rutten EH, van der Kogel AJ, Prick MJ, Keyser A, van der Maazen RW (2001) Reirradiation of primary brain tumours: survival, clinical response and prognostic factors. Radiother Oncol 59(2):127–137

    Article  PubMed  CAS  Google Scholar 

  17. Brandes AA, Franceschi E, Tosoni A, Bartolini S, Bacci A, Agati R, Ghimenton C, Turazzi S, Talacchi A, Skrap M, Marucci G, Volpin L, Morandi L, Pizzolitto S, Gardiman M, Andreoli A, Calbucci F, Ermani M (2010) O(6)-methylguanine DNAmethyltransferase methylation status can change between first surgery for newly diagnosed glioblastoma and second surgery for recurrence: clinical implications. Neurooncology 12(3):283–288

    CAS  Google Scholar 

  18. Felsberg J, Thon N, Eigenbrod S, Hentschel B, Sabel MC, Westphal M, Schackert G, Kreth FW, Pietsch T, Loffler M, Weller M, Reifenberger G, Tonn JC (2011) Promoter methylation and expression of MGMT and the DNA mismatch repair genes MLH1, MSH2, MSH6 and PMS2 in paired primary and recurrent glioblastomas. Int J Cancer 129(3):659–670

    Article  PubMed  CAS  Google Scholar 

  19. Helseth R, Helseth E, Johannesen TB, Langberg CW, Lote K, Ronning P, Scheie D, Vik A, Meling TR (2010) Overall survival, prognostic factors, and repeated surgery in a consecutive series of 516 patients with glioblastoma multiforme. Acta Neurol Scand 122(3):159–167

    Article  PubMed  CAS  Google Scholar 

  20. Clarke Dagger JL, Ennis Dagger MM, Yung WK, Chang SM, Wen PY, Cloughesy TF, Deangelis LM, Robins HI, Lieberman FS, Fine HA, Abrey L, Gilbert MR, Mehta M, Kuhn JG, Aldape KD, Lamborn KR, Prados MD (2011) Is surgery at progression a prognostic marker for improved 6-month progression-free survival or overall survival for patients with recurrent glioblastoma? Neurooncology 13(10):1118–1124

    Google Scholar 

  21. Park JK, Hodges T, Arko L, Shen M, Dello Iacono D, McNabb A, Olsen Bailey N, Kreisl TN, Iwamoto FM, Sul J, Auh S, Park GE, Fine HA, Black PM (2010) Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol 28(24):3838–3843

    Article  PubMed  Google Scholar 

  22. Ulmer S, Braga TA, Barker FG 2nd, Lev MH, Gonzalez RG, Henson JW (2006) Clinical and radiographic features of peritumoral infarction following resection of glioblastoma. Neurology 67(9):1668–1670

    Article  PubMed  CAS  Google Scholar 

  23. Smith JS, Lin H, Mayo MC, Bannerjee A, Gupta N, Perry V, Cha S (2006) Diffusion-weighted MR imaging abnormalities in pediatric patients with surgically treated intracranial mass lesions. J Neurooncol 79(2):203–209

    Article  PubMed  Google Scholar 

  24. Smith JS, Cha S, Mayo MC, McDermott MW, Parsa AT, Chang SM, Dillon WP, Berger MS (2005) Serial diffusion-weighted magnetic resonance imaging in cases of glioma: distinguishing tumor recurrence from postresection injury. J Neurosurg 103(3):428–438

    Article  PubMed  Google Scholar 

  25. Barker FG 2nd, Chang SM, Gutin PH, Malec MK, McDermott MW, Prados MD, Wilson CB (1998) Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery 42(4):709–720 discussion 720–703

    Article  PubMed  Google Scholar 

  26. Nimsky C, Ganslandt O, Tomandl B, Buchfelder M, Fahlbusch R (2002) Low-field magnetic resonance imaging for intraoperative use in neurosurgery: a 5-year experience. Eur Radiol 12(11):2690–2703

    PubMed  Google Scholar 

  27. Sawaya R, Hammoud M, Schoppa D, Hess KR, Wu SZ, Shi WM, Wildrick DM (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42(5):1044–1055 discussion 1055–1046

    Article  PubMed  CAS  Google Scholar 

  28. Vives KP, Piepmeier JM (1999) Complications and expected outcome of glioma surgery. J Neurooncol 42(3):289–302

    Article  PubMed  CAS  Google Scholar 

  29. Khan RB, Gutin PH, Rai SN, Zhang L, Krol G, DeAngelis LM (2006) Use of diffusion weighted magnetic resonance imaging in predicting early postoperative outcome of new neurological deficits after brain tumor resection. Neurosurgery 59(1):60–66 discussion 60–66

    Article  PubMed  Google Scholar 

  30. Kumabe T, Higano S, Takahashi S, Tominaga T (2007) Ischemic complications associated with resection of opercular glioma. J Neurosurg 106(2):263–269

    Article  PubMed  Google Scholar 

  31. Sanai N, Polley MY, Berger MS (2010) Insular glioma resection: assessment of patient morbidity, survival, and tumor progression. J Neurosurg 112(1):1–9

    Article  PubMed  Google Scholar 

  32. Simon M, Neuloh G, von Lehe M, Meyer B, Schramm J (2009) Insular gliomas: the case for surgical management. J Neurosurg 110(4):685–695

    Article  PubMed  Google Scholar 

  33. Smith GC, Pell JP (2003) Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ (Clinical research ed) 327(7429):1459–1461

    Article  Google Scholar 

  34. Lutsep HL, Albers GW, DeCrespigny A, Kamat GN, Marks MP, Moseley ME (1997) Clinical utility of diffusion-weighted magnetic resonance imaging in the assessment of ischemic stroke. Ann Neurol 41(5):574–580

    Article  PubMed  CAS  Google Scholar 

  35. Nonaka H, Akima M, Hatori T, Nagayama T, Zhang Z, Ihara F (2003) The microvasculature of the cerebral white matter: arteries of the subcortical white matter. J Neuropathol Exp Neurol 62(2):154–161

    PubMed  Google Scholar 

  36. Sanai N, Berger MS (2010) Intraoperative stimulation techniques for functional pathway preservation and glioma resection. Neurosurg Focus 28(2):E1

    Article  PubMed  Google Scholar 

  37. Wiedemayer H, Fauser B, Sandalcioglu IE, Schafer H, Stolke D (2002) The impact of neurophysiological intraoperative monitoring on surgical decisions: a critical analysis of 423 cases. J Neurosurg 96(2):255–262

    PubMed  Google Scholar 

  38. Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V (2011) Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 12(11):997–1003

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors would like to thank H. Ackermann, PhD for statistical advice.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Johann Wolfgang Goethe-University, Schleusenweg 2-16, Frankfurt am Main, 60528, Frankfurt/Main, Germany

    Stephan Dützmann, Florian Geßler, Johanna Quick, Kea Franz, Volker Seifert & Christian Senft

  2. Department of Neuroradiology, Johann Wolfgang Goethe-University, Schleusenweg 2-16, Frankfurt am Main, 60528, Frankfurt/Main, Germany

    Andrea Bink

Authors
  1. Stephan Dützmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Florian Geßler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea Bink
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johanna Quick
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kea Franz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Volker Seifert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christian Senft
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephan Dützmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dützmann, S., Geßler, F., Bink, A. et al. Risk of ischemia in glioma surgery: comparison of first and repeat procedures. J Neurooncol 107, 599–607 (2012). https://doi.org/10.1007/s11060-011-0784-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-011-0784-1

Keywords

Search

Navigation